EAZWV Transmissible Disease Fact Sheet Sheet No. 100

ACANTHAMOEBIASIS

ANIMAL TRANS- CLINICAL FATAL TREATMENT PREVENTION GROUP MISSION SIGNS DISEASE ? & CONTROL AFFECTED Gorillas, Unknown, Granulomatous Yes Clarithromycin, In houses Hylobatidae, probably amoebic Fluconazole, Colobidae, perorally encephalitis : Sulfadiazin, Papio spp., limb paresis, Fluorocytosine in zoos Mandrillus paralysis, ataxia Miltefosine sphinx

Fact sheet compiled by Last update Manfred Brack, formerly German Primate Center, 22.11.2008 Göttingen/Germany. Susceptible animal groups Gorilla gorilla, Hylobatidae, Papio spp., Colobidae, Mandrillus sphinx, man, dog. Causative organism (Acanthamoebidae). Zoonotic potential Yes. Distribution Worldwide. Widely distributed in fresh water, soil, and dust. Transmission Unknown. Experimentally transmitted by intranasal instillation. Incubation period > 10 days. Clinical symptoms Cutaneous granulomas, progressive limb paresis, hemiparesis, aphasia, seizures, cranial never paralysis (mainly 3. and 6. cranial nerve). Usually fatal within 2 months of symptom onset. Post mortem findings Random multifocal encephalomalacia and cerebral haemorrhages, nodular necroses in liver, kidney, lung, pancreas. Histology: poorly demarcated focal necroses, presence of trophozoites and cysts in the affected neuropil, necrotizing vasculitis. Diagnosis Methenamine silver- or PAS staining: presence of amoebic cysts in tissue sections ( Naegleria fowleri does not produce cysts in tissues !), growth on monkey kidney cells or human lung fibroblasts or fetal bovine serum containing media, CSF, indirect immunohistochemistry, PCR, electron microscopy, computer tomography. Material required for laboratory analysis Affected tissues (brain and skin biopsies). Relevant diagnostic laboratories

Treatment in man: Clarithromycin ( 500 mg 3 x daily), Sulfadiazine (1.58 g every 6 hs), 5- fluorocytosine ( 1,5 every 6 hs ), 2.5 mg/kg /day i.v. Miltefosine. Prevention and control in zoos

Suggested disinfectant for housing facilities

Notification

Guarantees required under EU Legislation

EAZWV Transmissible Disease Fact Sheet Sheet No. 100

Guarantees required by EAZA Zoos

Measures required under the Animal Disease Surveillance Plan

Measures required for introducing animals from non-approved sources

Measures to be taken in case of disease outbreak or positive laboratory findings

Conditions for restoring disease-free status after an outbreak

Experts who may be consulted

References 1. Anderson, M. P., J. E. Ooosterhus, S. Kennedy, and K. Benirschke. 1986. Pneumonia and meningoencephalitis due to in a lowland gorilla. J. Zoo Anim. Med. 17 : 87 – 91. 2. Foreman, O., J. S. Sykes, L. Ball, N. Yang, and H. De Cock. 2004. Disseminated infection with Balamuthia mandrillaris in a dog. Vet. Pathol. 41 : 506 – 510. 3. Huang, Z. H., A. Ferrante, and R. F. Carter. 1999. Serum antibodies to Balamuthia mandrillaris, a free – living amoeba recently demonstrated to cause granulomatous amoebic encephalitis. J. Infect. Dis. 179 : 1305 – 1308. 4. Intalapaporn, P., C. Suankratay, S. Shuangshoti, K. Phantumchinda, S. Keelawat, and H. Wilde. 2004. Balamuthia mandrillaris meningoencephalitis : The first case in Southeast Asia. Am. J. Trop. Med. Hyg. 70 . 666 – 669. 5. Martinez, A. J., and G. Visvesvara. 2001. Balamuthia mandrillaris infection. J. Med. Microbiol. 50 : 205 – 207. 6. Reed, R. P., C. M. Cooke – Yarborough, A. L. Jaquiery, K. Grimwood, A. S. Kemp, J. C. Su, and J. R. L. Forsyth. 1997. Fatal granulomatous amoebic encephalitis caused by Balamuthia mandrillaris. Med. J. Aust. 167 : 82 – 84. 7. Rideout, B. A., C. H. Gardiner, I. H. Stalis, J. R. Zuba, T. Hadfield, and G. S. Visvesvara. 1997. Fatal infection with Balamuthia mandrillaris ( a free – living amoeba ) in gorillas and other Old World primates. Vet. Pathol. 34 : 15 – 22. 8. Riestra – Castaneda, J. M., R. Riestra – Castaneda, A. A. Gonzalez – Garrido, P. P. Moreno, A. J. Martinez, G. S. Visvesvara, F. J. Careaga, J. L. O. de Alba, and S. G. Cornejo. 1997. Granulomatous amebic encephalitis due to Balamuthia mandrillaris ( Leptomyxidae ) : Report of four cases from Mexico. Am. J. Trop. Med. Hyg. 56 : 603 – 607. 9. Visvesvara, G. S., A. J. Martinez, F. L. Schuster, G. J. Leitch, S. V. Wallace, T. K. Sawyer, and M. Anderson. 1990. Leptomyxid ameba, a new agent of amebic meningoencephalitis in humans and animals. J. Clin. Microbiol. 28 : 2750 – 2756. 10. Wallace, R. S., A. Gendron – Fitzpatrick, J. A. Teare, and G. Morris. 1997. Leptomyxid amoebic meningoencephalitis in a Western lowland gorilla ( Gorilla gorilla gorilla ). Am. Assoc. Zoo Vet. Annu. Conf. Proc. 1997 : 59 – 61.